3.  You got called to put in an epidural for labor analgesia at 0430.  The insertion of the needle was uncomplicated.  You gave a bolus of 0.75% lidocaine with 2.5 ug/ml of epinephrine.  The patient got excellent pain relief from the bolus and you threaded the catheter in easily.  As you are taping the catheter in place, frank blood appears in the catheter. 

You pull back the catheter until the blood stops flowing in the catheter, tape it in place, and start the patient's infusion (1/8% bupivacaine with 2 ug/ml of fentanyl) at 10 ml/hr.

At 0730 you get a page and the labor nurse says the patient is in pain.

You,

a. Increase the infusion to 12 ml/hr

b. Give a bolus of lidocaine

c. Aspirate the catheter

d. Give a test dose of an epinephrine solution

 

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